During the past decade, controlling and limiting the spread of health care associated pathogens has become one of the more challenging aspects of health care epidemiology. Three pathogens posing significant nosocomial problems are Methicillin Resistant Staphylococcus Aureus (MRSA), Vancomycin Resistant Enterococcus (VRE), and Clostridium difficile (C. difficile). Their importance derives from a combination of resistance to presently available treatments and an ability to rapidly spread extensively in the environment around hospitalized patients. MRSA is present in wound infections, as often associated with bed sores and catheters. VRE is present in bowel and urinary tract infections. C. difficile is also present in bowel infections and presents as severe diarrhea. For each of these pathogens, control with presently available antibiotics is problematical, if not impossible. Accordingly, a more favorable way to combat the spread of these and other bacteria is through implementation of adequate cleaning and disinfecting procedures. When properly cleaned with a disinfection product, surfaces in close proximity to patients and surfaces that are most likely to be touched by patients and health care workers (e.g., high touch surfaces) do not serve as vectors to transmit infectious disease between patients. In other words, proper cleaning and disinfecting of these surfaces minimizes the risks of infectious outbreaks.
In 2002, the Centers of Disease Control (CDC) recommended that hospitals “thoroughly clean and disinfect environmental medical equipment surfaces on a regular basis”. More recently the draft guidelines for disinfection and sterilization in healthcare facilities developed by the CDC emphasize the importance of environmental cleaning and disinfection activities. Although these guidelines specifically state that hospitals should ensure compliance by housekeeping staff with cleaning and disinfecting procedures and ensure consistent cleaning and disinfection of surfaces in close proximity to the patient and likely to be touched by the patient and health care worker (e.g., high touch surfaces), these guidelines provide little in the way of directives regarding the means by which hospitals are to assess their ability to objectively measure the effectiveness of and/or compliance with such cleaning and disinfecting procedures.
Despite the foregoing, environmental hygiene and/or infection control supervisors are increasingly using the currently available cleaning confirmation methods and systems to improve outcomes and meet the increasingly strict regulatory demands. Current cleaning confirmation methods and systems involve direct observation, microbacterial detection (swab cultures or agar slide cultures), detection of markers indicative of microbial metabolism (ATP system), or pre-cleaning application of a transparent material that is subsequently checked for removal. The direct observation method is unduly burdensome on personnel and is highly susceptible to the Hawthorne Effect, which is also commonly referred to as the “observer effect” whereby subjects improve or modify an aspect of their behavior, which is being experimentally measured, in response to the fact that they know that they are being studied. The direct and the indirect microbial detection methods are time intensive and are costly to implement. Concerning the transparent material marker technique, while this technique is less susceptible to the Hawthorne Effect and is less expensive than the microbial detection methods, it requires the additional independent step of applying the transparent marker prior to the cleaning process and a subsequent determination of whether the marker has been washed away during the cleaning process.
Nevertheless, one commercial transparent material marker system currently in use involves the use of a fluorescein gel marker, which is later detected using a black light (i.e., ultra-violet radiation). The fluorescein systems and their use are disclosed in U.S. Pat. Nos. 7,785,109; 7,780,453; 7,718,395, and 8,435,933, for example. However, in addition to the independent application and verification steps, another drawback to the fluorescein systems is that the detection of the fluorescent marker requires the use of a black light.
Despite the aforementioned shortcomings, the current cleaning confirmation methods and systems are still useful tools for educating housekeeping and infection control workers and for monitoring compliance with cleaning protocols. However, none of these current cleaning confirmation systems determine the actual presence (or absence) of any disinfecting agents. In view of the above, there is a need for new cleaning and disinfection confirmation systems that can evaluate the thoroughness with which housekeeping activities are carried out in healthcare settings by detection of disinfecting agents.